Monday, January 02, 2006

Benefits of Illness: Post-traumatic stress disorder has been gaining momentum in the media lately. Doonesbury has been highlighting it for some time in the cartoon character of B.D., who lost his job and a leg in Iraq. And the December issue of the American Journal of Psychiatry is largely devoted to the issue. Last week, Dr. Helen noted the impending politicization of post-traumatic stress disorder heralded by this article from the Washignton Post. Most of the article focuses on the question of paying out disability benefits for the disorder. No one questions the disorder exists, but like other illnesses that are entirely dependent on subjective information and come with their own special financial compensation (such as work-related or accident-related chronic back pain, whiplash, and repetitive motion injuries), it is easily exaggerated - and sometimes out and out faked. What's more, since it's a purely psychological disorder, recovery from post-traumatic stress disorder is determined more by the psychology of the patient and his environment than by the extent of the trauma. As Dr. Helen points out, if a sufferer of PTSD is told he'll never recover, then he won't. If he resents the circumstances that put him in the way of trauma, if he's encouraged to assume the role of passive victim, whether by a therapist or by family and friends or by the conventional wisdom of society at large, then the recovery will be harder. Which is why the prospect of politicization is especially disheartening. And why this statement by a VA official in The Washington Post is especially concerning:

The growing national debate over the Iraq war has changed the nature of the discussion over PTSD, some participants said. 'It has become a pro-war-versus-antiwar issue,' said one VA official who spoke on the condition of anonymity because politics is not supposed to enter the debate. 'If we show that PTSD is prevalent and severe, that becomes one more little reason we should stop waging war. If, on the other hand, PTSD rates are low . . . that is convenient for the Bush administration.'

What side of the issue do you suppose he's on? And which side of the war debate stands to profit more by politicizing post-traumatic stress? No surprise, then, that there were not one, but two stories about PTSD in today's local paper - each with a local angle. One is the story of a reluctant soldier who says that no one is helping him, and the other is an interview with a psychologist who specializes in its treatment, and who believes it is the major morbidity of the war in Iraq, and that we'll be seeing an upsurge of cases locally as men and women return from the war. (They've been going and returning from the war for a couple of years now, so you would think there would be some concrete data instead of speculation, but never mind.)

Expect the media to continue to pound this meme. And as they do, remember that post-traumatic stress disorder is not unique to soldiers. Policemen and firemen suffer from it, too. Yet no one expects us to stop policing our streets or fighting fires to avoid psychological suffering in our police and fire departments. And most of all, let's not forget that those who live under a reign of terror can also suffer from post-traumatic stress disorder. I suspect that most of our soldiers recognize this. If only our politicians, and politicized VA officials, recognized it, too.

UPDATE: From a reader:

It is unfortunate that there is no commonly recognized way to rank the severity of PTSD. It leads to misunderstandings.

The experience from World War I, World War II, and Vietnam was that 2-5 percent per year of combat troops would require hospitalization for PTSD. This is not the few months rest and therapeutic conversations that was needed by nearly 100 percent of combat veterans, and that suffices for the more common PTSD of civilian life. You do not find 2-5 percent per year of police or firefighters needing hospitalization to deal with psychotic breakdowns due to PTSD.

It is also unfortunate that the politicians seem to be making this into a pro-war or anti-war thing rather than a support the troops issue. It was upsetting to see that at the same time we went into war the administration decided to cut VA medical funding. A more competent administration might realize that war means wounded soldiers, and wounded soldiers need medical treatment. When you go to war you need to increase VA medical funding because the seriously wounded veterans will be needing VA services for many years after their return.